Research Service, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA.
Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
J Womens Health (Larchmt). 2022 Oct;31(10):1450-1458. doi: 10.1089/jwh.2021.0529. Epub 2022 Mar 23.
Women service members of the past 20 years experienced high rates of traumatizing events resulting in pharmacological treatment. Post-military lives may include having children. Typically, Veterans Health Administration (VHA) patients' pregnancies are managed outside the VHA. This study examined medication exposures during pregnancy. The Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study collected primary survey data and linked secondary health care data from the VHA from 2015 to 2021. Medication fills and covariates were extracted for three 9-month periods: preconception, pregnancy, and postpartum. Multiple regression assessed factors associated with use during pregnancy of selective serotonin reuptake inhibitor (SSRI)/serotonin norepinephrine reuptake inhibitor (SNRI) or of non-recommended, potentially risky drugs, and of discontinuation of those medications from prepregnancy to pregnancy. The cohort comprised 501 women-29% Black, 65% White, and 6% other races, of whom 63% had 50%-100% service-connected disability. During pregnancy, 36% had a pain-related disorder, 19% major depression, and 18% post-traumatic stress disorder. The median number of drug classes prescribed during pregnancy was 5. The use of SSRI/SNRI antidepressants dropped from 36% preconception to 26% during pregnancy including new starts; 15% discontinued SSRI/SNRI. Comorbidity predicted medication use. Depression predicted discontinuing SSRI/SNRI during pregnancy; no predictors of discontinuing potentially risky drugs were identified. Based on prescriptions filled within the VHA only-ignoring potential community-based fills-women veterans were prescribed numerous medications during pregnancy and discontinued antidepressants alarmingly. Veterans of childbearing potential should receive counseling about medication use before pregnancy occurs. Their non-VHA obstetricians and VHA providers should share information to optimize outcomes, reviewing medications as soon as pregnancy is detected as well as after pregnancy concludes.
过去 20 年，女性军人经历了高比例的创伤性事件，导致需要药物治疗。退伍军人的生活可能包括生育子女。通常情况下，退伍军人健康管理局（VHA）的患者怀孕是在 VHA 之外管理的。本研究考察了怀孕期间的药物暴露情况。产妇和婴儿结局研究转化中心（COMFORT）研究从 2015 年到 2021 年，从 VHA 收集了初步调查数据并链接了二级医疗保健数据。在三个 9 个月的时间内提取了药物补充和协变量：受孕前、怀孕和产后。多元回归分析了与怀孕期间使用选择性 5-羟色胺再摄取抑制剂（SSRI）/5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）或不推荐、潜在危险药物相关的因素，以及从受孕前到怀孕期间停止使用这些药物的情况。该队列包括 501 名女性-29%为黑人，65%为白人，6%为其他种族，其中 63%有 50%-100%与服务相关的残疾。怀孕期间，36%有疼痛相关疾病，19%有重度抑郁症，18%有创伤后应激障碍。怀孕期间开的药物种类中位数为 5 种。SSRI/SNRI 抗抑郁药的使用率从受孕前的 36%降至怀孕时的 26%，包括新开始使用；15%停止使用 SSRI/SNRI。合并症预测药物使用。抑郁症预测怀孕期间停止使用 SSRI/SNRI；未发现停止使用潜在危险药物的预测因素。仅根据 VHA 内开具的处方-忽略潜在的社区内处方-退伍女军人在怀孕期间开了许多药物，并令人震惊地停止使用抗抑郁药。有生育能力的退伍军人在怀孕前应接受有关药物使用的咨询。他们的非 VHA 产科医生和 VHA 提供者应共享信息以优化结果，一旦发现怀孕，以及怀孕结束后，立即审查药物。
